Primary Insurance Carrier definition

Primary Insurance Carrier. Phone: Claim Address: City: Zip: Name of Insured: Relation to Client: Insured ID: Group #: Insured DOB: / / Phone: Employer: Insured’s address: City: Zip: Secondary Insurance Carrier: Phone: Claim Address: City: Zip: Name of Insured: Relation to Client: Insured ID: Group #: Insured DOB: / / Phone: Employer: Insured’s address: City: Zip:
Sample 1
Primary Insurance Carrier. Phone: Claims Address: City: State: Zip: Name of Insured: Relation to Client: Insured ID number: Group Number: Insured D.O.B.: Phone: Employer: Insured’s Address (if different than yours) Address: City: State: Zip: I hereby authorize the release of all medical information necessary to process an insurance claim. I hereby authorize my insurance company to make payments directly to Xxxxxx Xxxxx, LPC of Life Focus, Inc. I understand that I am financially responsible for all charges, regardless of insurance, unless otherwise written by Xxxxxx Xxxxx, LPC of Life Focus, Inc. I understand the financial policy established by Xxxxxx Xxxxx, LPC of Life Focus, Inc. I understand that balances left unpaid over 30 days from the date of service may be assessed a 1.5% re-billing/past due account fee (minimum $5.00) per month and/or may be referred to a collection agency to facilitate payment. Name (please print): Signature: Date: For office use only: *********************************************************************************** Authorization needed? Obtained? Auth #: # of visits authorized: Start Date: Exp Date: Deductible: Met: Co-pay/Co-ins: Benefits Limits: How much used? Marriage Therapy: Family Therapy:
Sample 1

Examples of Primary Insurance Carrier in a sentence

  • Financial and Billing Information Primary Insurance Carrier InformationNAME OF INSURED DATE OF BIRTH INSURANCE IDENTIFICATION # POLICY # (if applicable) GROUP # INSURED EMPLOYER PHONE # NAME OF INSURANCE CO.

  • Primary Insurance Carrier Subscriber Name Subscriber Date of Birth ID # Relationship to Patient 2.

  • Tournament results from the previous 6 months prior to the team nomination closing date.

  • Financial and Billing Information Primary Insurance Carrier InformationNAME OF INSUREDDATE OF BIRTHINSURANCE IDENTIFICATION #POLICY # (if applicable) GROUP #INSURED EMPLOYERPHONE #NAME OF INSURANCE CO.PHONE #ADDRESS OF INSURANCE CO.CITY STATE ZIP□ Self – Pay client (no insurance will be used).🙜 Filing for Secondary Insurance is the client’s responsibility.

  • Discussion / Possible Action regarding request from the Western Avenue Association to place canvas banners on the thirteen (13) light posts located on the west side of Western Avenue between Avondale and Wilshire.

  • A loss where the cost to repair or replace the collateral would exceed the Actual Cash Value, as determined by the Primary Insurance Carrier.

  • Financial and Billing Information Primary Insurance Carrier InformationNAME OF INSUREDDATE OF BIRTHINSURANCE IDENTIFICATION #POLICY # (if applicable) GROUP #INSURED EMPLOYERPHONE #NAME OF INSURANCE CO.PHONE #ADDRESS OF INSURANCE CO.CITY STATE ZIP□ Self – Pay client (no insurance will be used).

  • Health Insurance Information □YES □NO□YES □NO □YES □NO □YES □NO Primary Insurance Carrier: Policy ID Number: Telephone Number: Physician InformationPlease fill in the following information about the doctor prescribing Thyrogen for you.

  • Assignment/Direct Payment to Doctor Private/Group Accident and Health Insurance Patient: Primary Insurance Carrier: Secondary Insurance Carrier: Do you have an FSH, Flex Spending, etc.

  • If there is no Primary Insurance Carrier at the Date of Loss, Constructive Total Loss will be calculated as if primary insurance was intact using NADA marketvalue (the NADA “Clean Retail Value”) of the Vehicle.

Related to Primary Insurance Carrier

  • Primary insurance means the policies listed in this policy’s Umbrella Schedule.

  • Primary Insurance Policy Each policy of primary mortgage guaranty insurance or any replacement policy therefor with respect to any Mortgage Loan.

  • Insurance carrier means every insurance carrier duly

  • Special Primary Insurance Policy Any Primary Insurance Policy covering a Mortgage Loan the premium of which is payable by the Trustee pursuant to Section 4.04(a), if so identified in the Mortgage Loan Schedule. There are no Special Primary Insurance Policies with respect to any of the Mortgage Loans.

  • Fidelity Insurance means insurance coverage with respect to employee errors, omissions, dishonesty, forgery, theft, disappearance and destruction, robbery and safe burglary, property (other than money and securities) and computer fraud in an aggregate amount acceptable to Seller’s regulators.

  • Special Primary Insurance Premium With respect to any Special Primary Insurance Policy, the monthly premium payable thereunder. Statutory Trust Statute: Chapter 38 of Title 12 of the Delaware Code, 12 Del.C. §3801 et seq., as the same may be amended from time to time.

  • Health insurance carrier or "carrier" means any entity subject to the insurance

  • general insurance business means any class of insurance business other than long-term insurance business;

  • General Liability Insurance Subcontractor shall carry minimum primary General Liability Insurance for the following amounts:

  • Liability Insurance means compulsory professional liability errors and omissions insurance required by a governing body;

  • Insurance means comprehensive insurance of the vehicle(s)/equipment and shall include insurance of the crew.

  • D&O Liability Insurance Policies means all insurance policies (including any “tail policy”) of any of the Debtors for liability of any current or former directors, managers, officers, and members.

  • Company Insurance Policies has the meaning set forth in Section 4.15.

  • Co-insurance means the percentage of the usual, reasonable, customary, and fair market value expense that a covered person must pay.

  • First party insurance means an insurance policy or contract in which the insurer agrees to pay a claim submitted to it by the insured for the insured's losses.

  • Insurance Provider s Tender” means the completed Tendering Document submitted by the Insurance Provider to the Procuring Entity

  • group insurance means insurance, other than creditor’s group insurance and family insurance, whereby the lives of a number of persons are insured severally under a single contract between an insurer and an employer or other person; (“assurance collective”)

  • Professional liability insurance means insurance against legal liability incident to the practice of a profession and provision of a professional service.

  • Specified Insurance Company means any Entity that is an insurance company (or the holding company of an insurance company) that issues, or is obligated to make payments with respect to, a Cash Value Insurance Contract or an Annuity Contract.

  • FHA Insurance The contractual obligation of FHA respecting the insurance of an FHA Loan pursuant to the National Housing Act, as amended.

  • insurance business means one or more aspects of the business of selling, issuing or underwriting insurance or reinsurance.

  • Individual health insurance coverage means health insurance coverage offered to individuals in the

  • Property Insurance is defined in Section 6.10(a).

  • Travel Insurance means coverage for personal risks incidental to planned travel, including one or more of the following:

  • Insurance producer means a person required to be licensed under the laws of this state to sell, solicit or negotiate insurance, including annuities.

  • long-term insurance business means the business of providing or undertaking to provide policy benefits under long-term policies, but does not include -